215. Screening Polysomnography Reveals a High Prevalence of Sleep Disordered Breathing in Children with Myelomeningocele

Authors: Brandon G. Rocque, MD, MS, FAANS; Mary Halsey Maddox, MD; Betsy Hopson; Isaac Shamblin; Anastasia Arynchyna, MPH; Jeffrey Blount, MD (Birmingham, AL)

Introduction:

Previous retrospective studies of polysomnography (PSG) in children with myelomeningocele (MMC) identified a high prevalence of sleep disordered breathing (SDB). We sought to prospectively determine the prevalence of SDB in patients with MMC using screening PSG.

Methods:

All children seen in spina bifida clinic from 3/2016 to 12/2018 without an established diagnosis of SDB were referred if they had not previously had a PSG. We defined apnea/hypopnea index (AHI) of greater than or equal to 2.5 as abnormal and described apnea as obstructive, central, or both. Age, gender, race/ethnicity, hydrocephalus variables, functional level of lesion (FLOL), and body mass index (BMI) were examined as possible risk factors for SDB, using chi-square testing and logistic regression.

Results:

Ninety-three children underwent PSG, ages 1 month to 21 years (mean 9y); 45 (48%) were male. Mean BMI was 21. Approximately 1/3 of the children had sacral FLOL, 25% had mid-lumbar FLOL, and 10-15% had thoracic, high- or low-lumbar FLOL. Eighty-five (91%) had hydrocephalus, 72 of whom were treated with VP shunt and 13 with ETV/CPC.

The AHI range was 0-23.2, mean 3.35. Of 93 patients, 38% had AHI>2.5. Twenty-six children (28%) had obstructive apnea; 19 (20%) had central; and 13 (14%) had both. Only 35 children had no significant apnea. FLOL showed a significant association with presence of SDB (odds ratio varying from 3.8 to 9.5 for all FLOL compared to sacral, p=0.02). No other variable showed a significant correlation with presence of SDB.

Conclusion:

In this prospective study of children with MMC who underwent screening PSG, without significant history concerning for SDB or previous PSG, almost 40% have SDB. Patients with more rostral FLOL are at higher risk. We recommend consideration of PSG as part of the routine care of pediatric MMC patients, particularly those with thoracic and lumbar lesions.